Medical Biller
10 days ago
Ontario
Job Description Job Summary Medical Biller The Medical Biller reports to the Billing Manager in person at out office in Ontario, CA and is responsible for the accurate, compliant, and timely billing of clinical laboratory services, including blood testing, microbiology/culture testing, and toxicology services. This role requires strong expertise in Medicare Part A vs Part B billing, skilled nursing facility (SNF) workflows, and commercial payer laboratory billing rules. The Medical Biller manages claims from Pending Review through payment resolution while ensuring full compliance with Medicare, Medicaid, and commercial payor regulations. No Remote Work Available Supervisory Responsibilities Laboratory Billing & Claims Management • Review laboratory patient demographics, insurance, ordering provider, and facility information., • Prepare, review, and submit insurance claims for laboratory services provided by Brio Clinical Partners, including blood testing, microbiology/culture, and toxicology., • Accurately apply CPT, HCPCS, and ICD-10 codes in accordance with payer and regulatory guidelines., • Review claims for medical necessity in compliance with Medicare LCDs/NCDs and commercial payer policies., • Ensure proper toxicology billing, including correct differentiation between screening vs confirmatory testing, frequency limits, and unit reporting., • Identify and resolve coding, diagnosis, or documentation issues prior to claim submission., • Verify insurance eligibility and benefits prior to billing when required., • Identify payer authorization or referral requirements for laboratory services., • Accurately post payments, contractual adjustments, denials, and refunds from EOBs and ERAs., • Reconcile payments against Brio’s expected reimbursement schedules and contracted rates., • Research and resolve claim denials related to:, • Medicare Part A vs Part B determinations, • Medical necessity, • Coverage or authorization issues, • Coding or billing errors, • Prepare and submit appeals with supporting clinical and billing documentation., • Collaborate with skilled nursing facilities and internal teams regarding census reports, patient status, and billing responsibility., • Generate and manage client invoices for facility-responsibility or non-covered services., • Maintain accurate billing logs, work queues, and documentation., • Meet Brio Clinical Partners’ productivity, accuracy, and turnaround time standards., • Identify recurring billing issues and recommend workflow improvements., • Submit clean and accurate insurance claims (electronic and paper) in compliance with payer and regulatory guidelines, • Review claims for completeness, coding accuracy, and required documentation prior to submission, • Ensure timely filing limits are met for all payers, • Analyze Explanation of Benefits (EOBs) for accuracy of payments, adjustments, and denials, • Identify underpayments, incorrect contractual adjustments, and non-covered charges, • Identify claims eligible for negotiation and report them to the supervisor for review, • Escalate unresolved issues when necessary, • Perform systematic claim follow-up with insurance payers via portals, phone calls, and written correspondence, • Investigate delayed, pending, or lost claims and take corrective action, • Obtain claim status updates, reference numbers, and resolution timelines, • Identify payer trends impacting reimbursement or processing delays, • Performs other duties as assigned., • May assist with training, coaching, and the development of coworkers and students., • Must take all assigned Human Resources trainings and classes, • Minimum of 4–5 years of medical billing experience, with direct experience in clinical laboratory billing., • Medical billing certificate or degree, required., • Demonstrated experience billing blood testing, microbiology/culture testing, and toxicology services., • Strong working knowledge of:, • CPT, HCPCS, and ICD-10 coding, • Medicare Part A vs Part B laboratory billing, • SNF laboratory billing workflows, • Toxicology billing rules and frequency limitations, • Proficiency with billing systems, clearing houses, and payer portals., • Experience billing for skilled nursing facilities (SNFs), hospitals, or reference laboratories., • Familiarity with Medicare LCD/NCD policies related to laboratory and toxicology testing., • Prior experience with audits, appeals, or compliance reviews., • Strong analytical and problem-solving skills, • Clear written and verbal communication, • Ability to work independently and collaboratively, • Time management and organizational skills, • Prolonged periods of sitting and a desk and working on a computer., • Prolonged periods of standing and working at a copier.
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